Underweight Teens

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Teenage Daughter under-eating

Aug 2010

My 16 year old daughter has just been to the doctor. She gained 6'' but no pounds during puberty. She is 5'10'' and 105 lbs - ~35 pounds less than a normal/light teenager of that height. Her father and I were both ''sticks'' until puberty and she has always been a very thin child so I have not worried about it, but it seems she intends to remain stick-like.

Her doctor and I do not believe anorexia/bulimia is the problem. She rarely exercises, does not count calories, and can wolf down plates of food when she wants to. She seems completely uninterested in food unless it is handed to her on a platter. And believe me, I have busted my tail trying to serve her with a platter. For instance, I used to make her school lunch. No matter how hard I tried or what variety I brought to the lunch box, she was giving it away. She will not make her own lunch. Now she goes from breakfast to dinner on one bowl of cereal and there's nothing I can do about it. She is very picky, doesn't like to cook or prepare food, won't eat at mealtime if she is not hungry but may want to eat 2 hours later, and gets tired/bored of eating in mid-meal.

Her doctor has recommended she see a nutritionist and a psychologist. She believes my daughter is malnourished in that she is expending more calories than she is taking in.

I've got a few major concerns:

1) I don't want her eating issues to become her identity and worry that sending her to specialists will help solidify that. The label of eating disorder has potential to become her new life theme if she chooses to adopt it

2) Believe me - this is said with great amounts of Mom-guilt - I resent the dollars and time and energy this may take. I may have to turn my life upside down offering her multiple food options and meal times just to get her to gain a few pounds. My younger daughter can make breakfast and lunch and eats when we eat so it's frustrating to me to continually cater to the older.

3) I worry how she is going to get by on her own when she goes to college, given that she is not interested in changing and will probably not live with a short-order cook. If we throw dollars, time, and money at this will it not just be for naught if she moves out?

So - I need to hear from anyone who has dealt with this. Is the doctor over-reacting, under-reacting, should my daughter start in with a psychologist or nutritionist, am I a crummy mother? Help! Frustrated

As a parent of a teen with a serious eating disorder I encourage you to follow your daughter's doctor's advice and work with both a nutritionist and a therapist who specializes in working with teens with eating disorders. I understand your frustration and concern over the time, effort, money, and possible stigma involved with treatment, and your fears about the future. But starting now, with a team that understands the complexity of eating issues could prevent your daughter from developing an eating disorder and also give her the skills and support she needs to manage her eating in a healthy way both now and in the future. Michelle Vivas (510 595-9474) is an excellent nutritionist, very experienced in working with people with all kinds of eating behaviors, and an excellent resource for experienced therapists. Please feel free to email me if you would like to speak privately.

If your doctor has followed up on all possible tests for everything besides an eating disorder, and you have ruled out all diseases or conditions that might be causing under-eating, then it is certainly appropriate to consider an eating disorder. Not all eating disorders appear at first to fit into a one of the major diagnostic category. That's why eating disorders are often diagnosed as NOS, or Eating Disorder Not Otherwise Specified. With therapy and nutrition counseling and working closely with her doctor, your daughter may indeed end up with a diagnosis of anorexia or bulimia, but right now she needs to get some calories and to deal with the fact that her health is seriously compromised. Some doctors don't have enough experience with under-weight issues to realize when it becomes critical. There are lots of physical consequences from under-nourishment, including permanent loss of bone density and the potential for heart attack. 105 lbs at your daughter's height is pretty low. My best advice is to act AS IF your daughter has some kind of eating disorder and start working with a therapist and a nutritionist and a physician with experience. Mother who has been there

You definitely should see a nutritionist for your daughter-I recommend Michele Vivas. She is not covered by insurance, but she is worth the money. My daughter lost a bunch of weight, did not technically have an eating disorder, but Michele helped her tremendously-she gained 20 pounds in 3 months. Your daughter's weight is frighteningly low, this is not something to mess around with. Your pediatrician should also be checking her heart rate, and is she getting her period? Malnutrition is very serious, whatever the reason, and she needs to find a way to eat more. If anyone can do it, Michele can. Please call her ASAP. speak from experience

As a parent of a child who has suffered an eating disorder (and someone who had one herself), I can understand the fears you have about taking this seriously and getting your daughter outside help. It is expensive to pay for therapy, and you can feel like you're on an emotional rollercoaster when you really try to resolve a problem of this sort. But believe me - it will be the best money you ever spent. And the sooner you get your daughter help, the better off you and she will be (not to mention the rest of the family, as these problems will impact younger siblings too).

Eating disorders only get worse over time, and the weight/food issues that you are describing sound quite severe.

Also, from what you've written, I certainly wouldn't rule out aneorexia. People who try to control their food intake will sometimes eat large meals when they're feeling emotionally good, or may have good days and bad days. When they're young, they may not pay attention to calories, and may in fact eat high-fat and high-sugar foods occasionally without qualms. Eating disorders present differently in each case. But any young person who regularly gives up lunch and is purposely taking in less calories than she expends is facing a real problem.

We saw Deborah Waterhouse (a nutritionist) and felt like she was very helpful. She has an office in Orinda.

Good luck! -been there

Severely underweight and anxious young teen

Jan 2010

An experienced nutritionist urgently needed for severely underweight and anxious, ADD young teen with very low appetite. Failure to thrive complex issues, including depression. Ideally in Penninsula area but will consider others in Bay Area. Am open to Weston Price philosophy or other ideas. Desperate mom of super picky eater

Alta Bates Summit Med. Center at Herrick Campus in Berkeley has an excellent in-patient eating disorders program for teens and separate one for adults.

There is a new excellent program for teens with eating disorders at the Lafayette Women's Center which is affiliated with Alta Bates Medical Center. They have a nutritionist on staff and work also very closely with the Herrick Campus of Alta Bates. Apparently, people are flying in from out of state to have consultations here. Best of luck. local MD